Clinical Analysis Of 23 Cases Of Uterine Smooth Muscle Tumors Of Uncertain Malignant Potential

Objective : This retrospective study was designed to analyze the clinical symptoms?presentations of the auxiliary examination?clinical treatment and prognosis of the patients diagnosed as Uterine Smooth Muscle Tumor of Uncertain Malignant Potential(STUMP)with spindle cell differentiation.Materials and Methods: A retrospective analysis was used in this study.All cases were admitted and received surgery treatment in the Beijing Military General Hospital from 2009 January 1 to 2015 December 30.All cases were spindle cell type differentiation and were defined as Uterine Smooth Muscle Tumors of Uncertain Malignant Potential by pathology.All the original cases were searched from Patient's Electronic Medical Records Management System of the hospital.We recorded the patient's Identification Numbers if the pathological report or the final diagnosis corresponded with STUMP.The original surgical specimens of the selected patients were reviewed by a same group of pathologists,using the pathological criteria proposed in 1994 by Bell and other investigators at Stanford University to identify STUMPs.Our study only included the patients who were re-diagnosed as STUMP by “Stanford criteria” and the STUMPs represented spindle cell type differentiation.The medical record information of the patients was recorded.The information of prognosis obtained from outpatient follow-up,telephone follow-up,and the medical record who was admitted again.If recurrence or metastasis occurred after surgery,the pathological slides of the recurrent lesions were reviewed by a experienced pathologist.Result:1.General situation: Twenty-three patients meet the requirements and are included in this study.All patients are premenopausal or perimenopausal women.The number of the patients whose age range from 40 to 50 is the most,followed by 30 to 40 years old patients.None of the 23 patients is postmenopausal woman or adolescent girl.2.Clinical symptoms: Majority patients had similar symptoms with the patients who suffer from uterine leiomyomas,such as:menorrhagia,abnormal uterine bleeding.They can show a variety of clinical symptoms at the same time.3.Auxiliary examination: Preoperative ultrasound didn't identified all of the uterine STUMPs effectively.STUMPs were misclassified as benign uterine leiomyomas in 22 patients by ultrasound examination.1 case of STUMP was misdiagnosed as a big pelvic mass by ultrasound before the surgery,originating from ovary was considered.Sixteen patients were examined tumor markers(CEA,AFP,CA125,CA199)before the initial surgery.CA125 increased mildly in 2 cases.The rest of the tumor markers ranged within normal level in all of the patients.4.Operation method and Intraoperative findings: All patients underwent surgery.Six cases were treated by myomectomy via laparoscopy?hysteroscopy or laparotomy as their initial surgical intervention;13 cases were treated by total hysterectomy alone(laparoscopy or laparotomy);4 cases underwent laparoscopic myomectomy,followed by total laparoscopic hysterectomy after several days.Thirteen cases of STUMPs were cut in the surgeries and recorded explicitly in the medical record.Eleven cases have the similar appearances with benign leiomyomas,however other two cases present degeneration in appearance.5.Follow up and Prognosis: Nineteen patients were followed up,four patients were lost to follow up.Among the 19 patients,2 cases(1 case underwent abdominal myomectomy,1 case underwent laparoscopic myomectomy)relapsed in the follow-up period.The recurrence rate is 8.7%,if the four cases who were lost to follow-up had no recurrence.6.The comparison of recurrence rate: The difference of recurrence rate has no statistical significance between women who underwent myomectomy and those who underwent hysterectomy to treat uterine STUMP.Conclusion:1.Patients who suffer from STUMP may have similar symptoms with the patients who have uterine leiomyoma or leiomyosarcoma.But the clinical symptoms and demographic characteristics(such as age distribution)of STUMPs are more similar with benign smooth muscle tumors.2.In general,STUMPs have the same pelvic ultrasound images with benign uterine leiomyoma.It is difficulty to distinguish these two tumors.The degree of specificity and sensitivity of serum tumor markers(such as: AFP,CEA,CA199 and CA125)is low when they are used to diagnose STUMPs.3.Most STUMPs are the intramural tumors and have the similar appearances with benign leiomyomas.4.The difference of recurrence rate has no statistical significance between women who underwent myomectomy and those who underwent hysterectomy to treat uterine STUMP.5.STUMPs have the possibility of recurrence after operation,so a closely follow-up is needed.